ABSTRACT Hurricane Maria made landfall in Puerto Rico (PR) on September 20, 2017 as Category 5 storm, killing at least 64 people and causing an estimated $90 billion in damage. Cancer patients are particularly vulnerable to the devastation caused by Maria; it is estimated that 90% of patients have experienced interruptions in their care. The current study will describe unmet medical and psychological needs as well as barriers and facilitators to care in cancer patients in PR. In addition, Maria presents a unique opportunity to study the intersection of stress and cancer, specifically the impact of extreme physical and mental stress on hypothalamic-pituitary-adrenal (HPA) axis functioning which is known to affect cancer biology. Study aims are to: 1) to describe unmet medical and psychological needs over time among cancer patients in PR affected by Hurricane Maria, 2) to identify multilevel barriers and facilitators to access to care, and 3) to explore putative physiological markers of stress in patients and a matched sample of non-cancer controls affected by Hurricane Maria. The current study leverages a longstanding U54-funded partnership between Ponce Health Sciences University (PHSU) and Moffitt Cancer Center. Resources include an Community Outreach Core and the Puerto Rico Biobank as well as a history of collaboration among members of the research team.